No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.
And yet, statistically, caloric restriction has one of the worst success rates in modern medicine.
Depending on which study you look at, up to 80% of people who attempt lifestyle modification end up gaining the weight right back.
So yes, it's theoretically possible for everyone under ideal circumstances, but in the real world most people don't succeed. We can argue over why that happens - but the statistics remain.
So again... given these abysmal odds, for the 80% of people who try and (repeatedly) fail at lifestyle modification, what is the least bad alternative?
I think we’re saying the same thing? The only difference is that I personally don’t believe that self-control is sufficient for everyone to lose weight. If you do believe that, then the risk estimates become much easier.
